The Association of Diabetes With Knee Pain Locations, Pain While Walking, and Walking Speed: Data From the Osteoarthritis Initiative

A Scoping Review of the Predictive Qualities of Walking Speed in Older Adults

BACKGROUND AND PURPOSE

Walking speed (WS) is an easily assessable and interpretable functional outcome measure with great utility for the physical therapist providing care to older adults. Since WS was proposed as the sixth vital sign, research into its interpretation and use has flourished. The purpose of this scoping review is to identify the current prognostic value of WS for the older adult.

METHODS

A scoping review was conducted using PubMed, CINAHL, and SPORTDiscus to find relevant articles highlighting the predictive capabilities of WS for older adults. Titles and abstracts were reviewed to identify relevant articles. Articles were excluded based on the following criteria: sample included both younger and older adults without separate analyses, sample was focused on a particular disease, if the study was published before 2017, or if the study did not report relevant cut points for interpretation of WS. The search returned 1064 results. Following removal of articles not meeting inclusion criteria and critical appraisal, relevant cut points were extracted from 47 original research publications.

RESULTS AND DISCUSSION

A preliminary review of the included articles showed that WS is a valuable prognostic tool across many health domains, including mental health, mortality, disability, pain, bone and joint health, falls, cognition, physical activity, metabolic health, risk for cardiovascular disease, socialization, and metabolic health. The fastest WS of 1.32 meters per second (m/s) served as a cutoff for decreased risk for incident development of type 2 diabetes, while the slowest WS of less than 0.2 m/s was associated with increased duration of hospitalization. Multiple studies reported on the prognostic value of WS slower than 1.0 m/s.

CONCLUSION

Although the reported range of predictive WS values was broad, multiple studies found WS of approximately 1.0 m/s to be a useful marker for delineating risk or decline across a variety of health domains. Clinicians may find it useful to use a WS slower than 1.0 m/s as a "yellow flag" to guide evaluation and intervention for their older adult clients.

A Longitudinal Decline in Walking Speed Is Linked with Coexisting Hypertension and Arthritis in Community-Dwelling Older Adults

Objective: The aim was to investigate the association between baseline coexistence of hypertension (HTN) and arthritis, HTN alone, or arthritis alone, and their impact on longitudinal physical function measures among community-dwelling older adults over 5 years of follow-up. Methods: Ours was a longitudinal prospective cohort study from the second wave (2010-2011) and third wave (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Data for older adults were used. Participants were categorized based on self-reported diagnoses into four groups: coexisting HTN and arthritis, HTN only, arthritis only, or neither. Physical performance measures included walking speed using the 3-Meter Walk Test and the Five Times Sit-to-Stand Test (FTSST). Multiple generalized estimating equations with linear regression analyses were conducted, adjusting for age, sex, race, body mass index (BMI) educational level, pain severity, and baseline use of pain and hypertension medications. Results: Data for 1769 participants were analyzed. Slower walking speed was only associated with coexisting HTN and arthritis (B = -0.43, p < 0.001) after accounting for covariates. The coexisting HTN and arthritis group showed no significant association with FTSST (B = 0.80, p = 0.072) after accounting for covariates. Conclusions: The coexistence of baseline HTN and arthritis in older adults is associated with a gradual decline in only walking speed as a physical performance measure in older adults.

Diabetes is associated with longitudinal declined physical performance measures in persons with or at risk of knee osteoarthritis: data from the Osteoarthritis Initiative

BACKGROUND

The primary aim of this study was to longitudinally examine the impact of diabetes mellitus (DM) on physical performance measures including Gait Speed and Chair Stand tests over 8 years of follow-up in people with or at risk of knee osteoarthritis (OA).

DESIGN

A prospective longitudinal study.

SETTING

Multisite community based.

POPULATION

This study included participants with or at risk of knee OA aged from 45 to 79 years from the Osteoarthritis Initiative from baseline to 96 months follow-up.

METHODS

The participants performed physical performance measures using a 20 m Walk Test for Gait Speed and 5 Times Sit To Stand for repeated chair stand test time at baseline and during follow-up visits. Participants were asked about the presence of diabetes mellitus (DM) at baseline and categorized into with or without DM. Generalized estimating equations were utilized with 2 models, one for DM and Gait Speed and the other for DM and Repeated Chair Stand Test after controlling for covariates including age, sex, education, Body Mass Index (BMI), depressive symptoms, physical activity level, baseline number of comorbidities, and baseline Kellgren and Lawrence grades for OA grading for each knee.

RESULTS

A total of 4796 participants were included and categorized into those with DM (N.=362) and without DM (N.=4311) at baseline. Participants with DM at baseline showed significantly declined gait speed (B=-0.048, 95% Confidence Interval [95% CI]: [-0.07, -0.02], P<0.001) and significantly an increased time for repeated chair stand test (B=0.49, 95% CI: [0.08, 0.89], P=0.018) over time when compared to those without DM at baseline, after controlling for covariates.

CONCLUSIONS

DM was associated with negative impact on Gait Speed and Repeated Chair Stand Test time in individuals with or at risk of knee OA. Individuals with knee OA and diabetes who exhibit declining physical performance measures are at risk of functional dependence, reduced quality of life, and complex rehabilitation requirements.

Association between High HbA1c Levels and Mast Cell Phenotype in the Infrapatellar Fat Pad of Patients with Knee Osteoarthritis

Diabetes mellitus (DM) has been suggested as a potential risk factor for knee osteoarthritis (KOA), and its underlying mechanisms remain unclear. The infrapatellar fat pad (IPFP) contributes to OA through inflammatory mediator secretion. Mast cells' (MCs) role in diabetic IPFP pathology is unclear. In 156 KOA patients, hemoglobin A1c (HbA1c) was stratified (HbA1c ≥ 6.5, n = 28; HbA1c < 6.5, n = 128). MC markers (TPSB2, CPA3) in IPFP were studied. Propensity-matched cohorts (n = 27 each) addressed demographic differences. MC-rich fraction (MC-RF) and MC-poor fraction (MC-PF) were isolated, comparing MC markers and genes elevated in diabetic skin-derived MC (PAXIP1, ARG1, HAS1, IL3RA). TPSB2 and CPA3 expression were significantly higher in HbA1c ≥ 6.5 vs. <6.5, both before and after matching. MC-RF showed higher TPSB2 and CPA3 expression than MC-PF in both groups. In the HbA1c ≥ 6.5 group, PAXIP1 and ARG1 expression were significantly higher in the MC-RF than MC-PF. However, no statistical difference in the evaluated genes was detected between the High and Normal groups in the MC-RF. Elevated TPSB2 and CPA3 levels in the IPFP of high HbA1c patients likely reflect higher numbers of MCs in the IPFP, though no difference was found in MC-specific markers on a cell-to-cell basis, as shown in the MC-RF comparison. These findings deepen our understanding of the intricate interplay between diabetes and KOA, guiding targeted therapeutic interventions.

Hypertension Is Associated with Joint Pain Severity Among Individuals with Osteoarthritis

Previous studies have reported an association between hypertension (HTN) and osteoarthritis (OA). However, limited research has examined the association between HTN and symptoms, such as pain severity, in people with OA. Therefore, the aim was to investigate the prevalence of HTN in individuals with OA and the association between HTN and pain severity in this population. This study was cross-sectional and included participants aged 50 years and older from the community. Demographic data were included and self-reported history of chronic illnesses including diabetes, HTN, cardiovascular disease, dyslipidemia, anemia, osteoporosis, neurological disease, and back pain were obtained. Numerous medications and chronic diseases were included. A subsample of people who self-reported osteoarthritis was included in this study. Pain severity was measured over the past 7 days using a pain numeric rating scale. Multiple linear regression was used after adjusting for covariates. A total of 82 participants with OA were included, and the prevalence of HTN among individuals with OA was 28.91%. Hypertension was significantly associated with increased joint pain severity in this population after adjustments for covariates (B=1.81; 95% CI, 0.65, 2.97; p = .003). Hypertension is prevalent in individuals with OA and is significantly associated with pain severity in this population. Future research should consider the effect of HTN control and medication on symptoms in people with OA. Clinicians may implement screening for HTN among individuals with OA because of the association between HTN and symptoms, such as pain, in this population.

Osteoarthritis and Diabetes: Where Are We and Where Should We Go?

Diabetes mellitus (DM) and osteoarthritis (OA) are chronic noncommunicable diseases that affect millions of people worldwide. OA and DM are prevalent worldwide and associated with chronic pain and disability. Evidence suggests that DM and OA coexist within the same population. The coexistence of DM in patients with OA has been linked to the development and progression of the disease. Furthermore, DM is associated with a greater degree of osteoarthritic pain. Numerous risk factors are common to both DM and OA. Age, sex, race, and metabolic diseases (e.g., obesity, hypertension, and dyslipidemia) have been identified as risk factors. These risk factors (demographics and metabolic disorder) are associated with DM or OA. Other possible factors may include sleep disorders and depression. Medications for metabolic syndromes might be related to the incidence and progression of OA, with conflicting results. Given the growing body of evidence indicating a relationship between DM and OA, it is vital to analyze, interpret, and integrate these findings. Therefore, the purpose of this review was to evaluate the evidence on the prevalence, relationship, pain, and risk factors of both DM and OA. The research was limited to knee, hip, and hand OA.

Associations between obesity, diabetes mellitus, and cardiovascular disease with progression states of knee osteoarthritis (KOA)

BACKGROUND

Data on common comorbidities targeting at different progression states of knee osteoarthritis (KOA) in continuous time are limited.

AIMS

To examine the associations between obesity, diabetes mellitus (DM), and cardiovascular disease (CVD) with the progression of KOA.

METHODS

Data were obtained from the Osteoarthritis Initiative for up to 48 months. Progression states of KOA were defined as (1) normal; (2) asymptomatic radiographic KOA (RKOA, Kellgren-Lawrence grade ≥ 2 in at least one knee); (3) only knee symptoms; (4) symptomatic KOA (SxKOA, a combination of RKOA and knee symptoms in the same knee). A multi-state Markov model was used to investigate the associations while accounting for potential confounders.

RESULTS

Participants with obesity had an increased risk of developing RKOA [normal to asymptomatic RKOA, adjusted hazard ratio (aHR) 1.55, 95% confidence interval (95% CI) (1.07, 2.24); only knee symptoms to SxKOA, aHR 2.25, 95% CI (1.60, 3.18)], and an increased risk of developing knee symptoms [normal to only knee symptoms, aHR 1.45, 95% CI (1.15, 1.83); asymptomatic RKOA to SxKOA, aHR 1.33, 95% CI (1.16, 1.52)]. DM was also significantly associated with development of RKOA or knee symptoms [normal to asymptomatic RKOA, aHR 1.92, 95% CI (1.12, 3.30); normal to only knee symptoms, aHR 1.78, 95% CI (1.12, 2.84)]. Knee symptoms were less likely to be relieved among participants with CVD, compared with those without [only knee symptoms to normal, aHR 0.60, 95% CI (0.38, 0.94)].

CONCLUSIONS

Obesity, DM and CVD are associated with an increased risk for SxKOA progression. Common comorbidities should be considered to prevent KOA development.

The Regional Burden and Disability-Adjusted Life Years of Knee Osteoarthritis in Kazakhstan 2014-2020

A Global Burden of Disease (GBD) study reported that 9.6 million years lived with disability (YLDs) were lost due to hip and knee osteoarthritis (KOA) in 2017. Although the GBD study presents the disease burden at the global level, there is no information on any Central Asian country. This study aims to investigate the epidemiology of knee osteoarthritis in Kazakhstan. The data of 56,895 people with KOA between 2014-2020 was derived from the Unified National Electronic Health System of Kazakhstan and retrospectively analyzed. The majority of the cohort (76%) were women, of Kazakh ethnicity (66%), and older than 50 years of age (87%). The risk of gonarthrosis escalated for women after 50 years and peaked at 75 years with a rate of 3062 females admitted to hospital per 100,000 women in the population. This observation is approximately three times higher than for men of the same age group. A geographical analysis showed that the Jambyl oblast, West Kazakhstan, North Kazakhstan, and the Akmola oblast have the highest burden of disease. During the observation period, 127,077 age-adjusted YLDs were lost due to knee osteoarthritis. This is the first study in Kazakhstan to investigate the burden of knee osteoarthritis. This research recognizes age and sex-based differences, and regional disparities in the incidence of knee osteoarthritis. This knowledge can lead to the development of more specific diagnostic approaches and gender-personalized therapy protocols for patients.

Gait Speed as a Predictor for Diabetes Incidence in People with or at Risk of Knee Osteoarthritis: A Longitudinal Analysis from the Osteoarthritis Initiative

BACKGROUND

This study examined the association between baseline gait speed with incident diabetes mellitus (DM) among people with or at elevated risk for knee OA.

MATERIALS AND METHODS

Participants from the Osteoarthritis Initiative, aged 45 to 79 years, where included. Participants with or at risk of knee OA from baseline to the 96-month visit were included. Participants with self-reported DM at baseline were excluded. DM incidence was followed over the 4-time points. Gait speed was measured at baseline using a 20-m walk test. Generalized estimating equations with logistic regression were utilized for analyses. Receiver operator characteristic curves and area under the curve were used to determine the cutoff score for baseline speed.

RESULTS

Of the 4313 participants included in the analyses (58.7% females), 301 participants had a cumulative incidence of DM of 7.0% during follow-up. Decreased gait speed was a significant predictor of incident DM (RR 0.44, p = 0.018). The threshold for baseline gait speed that predicted incident DM was 1.32 m/s with an area under the curve of 0.59 (p < 0.001).

CONCLUSIONS

Baseline gait speed could be an important screening tool for identifying people at risk of incident diabetes, and the determined cutoff value for gait speed should be examined in future research.

Decrease in opioid and intra-articular corticosteroid burden after intra-articular hyaluronic acid for knee osteoarthritis treatment

Aim: We studied changes in opioid prescriptions and corticosteroid injection use for knee osteoarthritis patients before and after intra-articular hyaluronic acid (HA) use and opioid prescriptions before and after knee arthroplasty (KA). Materials & methods: A total of 1,017,578 knee osteoarthritis members were ascertained from a commercial claims database (Health Intelligence Company LLC, IL, USA) using ICD9/ICD10 diagnosis codes. Results: Eighty two percent of HA patients did not fill opioid prescriptions postinjection, with 54% of opioid users discontinuing fills. Two-thirds of KA patients filled opioid prescriptions within 6 months postsurgery, with 78% of opioid users continuing fills and 62% of nonusers initiating use. Conclusion: Alternative therapies, such as HA, that reduce opioid use may alleviate opioid addiction risks for KA patients who use opioids in the pre- and postoperative periods.

Combined diabetes and arthritis are associated with declined gait speed

This study investigated the association of combined arthritis and diabetes, diabetes only, and arthritis only compared with neither with gait speed in the general population. This cross-sectional study included data from the second wave of Midlife in the United States-2 (MIDUS 2) project 4: Biomarker Project, 2004-2009. The MIDUS 2 biomarker project included 1255 individuals aged between 34 and 84 years. Participants were categorized into four groups: combined arthritis and diabetes, diabetes only, arthritis only, or neither. The main outcome measure was gait speed measured by the 50-ft walk test. Covariates included age, gender, body mass index (BMI), depression symptoms, and number of chronic conditions/symptoms. A total of 1255 participants were included with mean age 54.52 ± 11.71, of those 713 (56.8%) participants were females. The results showed that combined arthritis and diabetes was significantly associated with a greater decline in gait speed (B = - 0.11, 95% confidence interval (CI) [- 0.17 to - 0.6], p < 0.001). Arthritis and diabetes were independently significantly associated with decreased gait speed (B = - 0.072, 95% CI [- 0.10 to - 0.043], p < 0.001), (B = - 0.064, 95% CI [- 0.12 to - 0.012], p = 0.015), respectively. Combined arthritis and diabetes was associated with a greater decline in gait speed compared with diabetes only, arthritis only, or neither group. Key Points • Combined arthritis and diabetes were associated with declined gait speed. • Gait speed did not differ between people with arthritis compared with people with diabetes. • We recommended including gait speed assessment in regular clinical visits to capture gait speed declines for further health assessments.